[Diagnostic tools for acute coronary syndrome (ACS): a challenge for general practitioners and cardiologists]

In cardiology, diagnostic tools for ruling acute coronary syndrome (ACS) in or out are becoming more and more sensitive. In general practice, diagnostic means to discriminate between ACS and less demanding causes of chest complaints remain poor. Both situations challenge physicians working in their respective fields. Cardiologists have to deal with a decrease in specificity due to the increasing sensitivity of high-sensitivity troponin and face the dilemma of whether or not to perform invasive coronary angiography in cases of doubt. General practitioners on the other hand are still lacking adequate diagnostic tools. These difficulties are illustrated in three cases where patients present chest complaints in primary care and are eventually referred to a cardiologist. Notwithstanding the presence of the aforementioned dilemmas, combining clinical reasoning with current definitions of ACS and myocardial infarction leads to an unambiguous diagnosis in all three cases.